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Biomedical subjects

K Curtis

Publications and source records attributed to K Curtis.

At least 19 recordsLinked to original sources
PubMed2006

Children as partners with adults in their medical care.

AIMS: To investigate the seldom published views of children with type 1 diabetes about their condition and ways in which they share in managing their medical and health care with adults. METHODS: Semi-structured, tape recorded interviews, during 2003, with a purposive sample of 24 children aged 3-12 years who have type I diabetes and who attend two inner London hospitals and one hospital in a commuter town. RESULTS: The children reported high levels of understanding, knowledge, and skill gained from their experience of living with diabetes and constantly having to take account of the condition and their paediatrician's guidance. Their key goals were to be "normal" and "just get on with their lives". DISCUSSION: The interviews showed that children's experiences of diabetes tended to enable them to make informed, "wise" decisions in their own best interests, even at a young age. They achieved a complicated balance between the sometimes competing goals of social health "being normal" and physiological health in controlling glycaemia. Their competence supports approaches in children's rights and in policy makers' aims that people with diabetes--including children--gain more knowledge, skills, and responsibility for their own care in partnership with healthcare professionals. Consent is usually considered in relation to surgery; however the children showed how they constantly dealt with decisions about consent or refusal, compliance with, or resistance to their prescribed treatment. Their health depends on their informed commitment to medical guidance; more research is needed about the daily realities of children's committed and responsible co-management of their chronic illness.

Adult↗
PubMed2004

Putting public health evidence into practice: increasing the prevalence of working smoke alarms in disadvantaged inner city housing.

STUDY OBJECTIVES: The UK government recommends that local authorities install battery operated smoke alarms to prevent fire related injury. However, a randomised controlled trial of smoke alarm installation in local authority housing found a low level of working alarms at follow up. Qualitative work, which accompanied the trial explored barriers and levers to the use of this public health intervention. DESIGN: Semi-structured group and individual interviews were conducted with a sample of the adult participants in a randomised controlled trial of free smoke alarm installation. Group interviews and "draw and write" exercises were conducted with children at a local primary school. PARTICIPANTS: A sample of trial participants and primary school children in the trial neighbourhood. SETTING: An inner city housing estate in central London. MAIN RESULTS: The main barrier to smoke alarm use was the distress caused by false alarms. Although trial participants considered themselves to be at high risk for fires and would recommend smoke alarms to others, respondents' reports on the distress caused by false alarms suggest that people balance immediate and longer term risks to their health and wellbeing when they disable alarms. CONCLUSIONS: This study identified some of the reasons for the low level of functioning smoke alarms, and problems experienced with alarms. The results have implications for the implementation of this public health intervention. The effectiveness of smoke alarm installation could be improved if alarm manufacturers and those responsible for implementation programmes considered ways of tackling the issues raised in this study.

Accident Prevention↗
PubMed2001

Do community-based support services benefit bereaved children? A review of empirical evidence.

AIMS: To consider the evidence of effect from English language, empirically based quantitative evaluations of community-based interventions for bereaved children; community-based interventions being understood as those taking place outside a clinical setting. METHODS: MedLine, PsychInfo, Applied Social Sciences Index and Sociological Abstracts were searched for documents containing the words 'child', 'bereavement' and 'program', 'group', 'intervention', 'support' or 'evaluation'. The criterion for inclusion was that studies use a control group or pre- and post-test measurements using a standardized instrument. RESULTS: Nine relevant studies were identified. However, empirical evidence of positive outcomes for children was limited and compromised by methodological weaknesses in the design of the studies. Small sample sizes, irregular attendance, high levels of attrition, short time scales between pre- and post-testing and difficulty in developing appropriate instrumentation, including assessment of adherence to the agreed intervention programme, all created problems. CONCLUSIONS: The case for universal inclusion of this group of children in such support programmes remains unproven, and further exploration of the outcomes of a range of different community interventions is required, with a specific focus on long-term and/or unwanted effects and evaluation of the basis for referral.

Bereavement↗
PubMed2000

Refractory hypotension in trauma: a case study.

In the patient with blunt trauma, diagnosis of the cause of ongoing hypotension may be difficult. A number of causes may contribute to refractory hypotension, either alone or in combination. However, by following standard algorithms for the management of these patients, causes can be excluded or identified, then managed appropriately. The following case study highlights one of the diagnoses of exclusion for refractory hypotension in the blunt trauma victim. Ongoing considerations and implications for the nursing care of spinal injured patients are also discussed.

Aged↗
PubMed1998

Operational psychology countermeasures during the Lunar-Mars Life Support Test Project.

The Crew and Thermal Systems Division at the NASA Johnson Space Center conducted a series of human-rated tests, termed the Lunar-Mars Life Support Test Project (LMLSTP), designed to advance technology in closed life support systems. As the duration of these tests lengthened, the psychological factors associated with placing humans in these environments became increasingly salient to successful mission completion. A number of psychological activities were conducted to ensure successful operations and protect crew member well-being, including individual crew member selection, crew composition, training and preparation, family inclusion, educational briefings, in-mission tracking, operational interventions, and postmission repatriation. This article describes these activities, the rationale behind their design, the similarities and differences to techniques utilized for spaceflight, and considerations related to designing psychological countermeasures for confined environments. In addition to testing physical and engineering systems, the LMLSTP series functioned as an effective testbed for developing operational concepts and countermeasures for extended space missions.

Adaptation, Psychological↗
PubMed1994

Total quality improvement according to hospital nursing executives.

Total quality management (TQM) is certainly a hot topic in health care today. The Department of Veterans Affairs is not alone in launching the quality movement in their hospitals. The question is, can it succeed. The success of total quality lies in the commitment of the organizations' leaders. Nursing leadership has yet to be studied regarding TQM implementation. Nursing performs a vital role in hospitals, and if nursing leaders are opposed to total quality, then it is highly unlikely that the philosophy will succeed. This study is designed to measure the attitudes and perceptions of VA nursing chiefs regarding the total quality improvement (TQI) process.

Attitude of Health Personnel↗
PubMed1993

Hippocampal damage does not impair instrumental appetitive conditioning with delayed reinforcement.

The present study evaluated the effects of bilateral hippocampal lesions on appetitive instrumental conditioning with delayed (5-s interval) reinforcement in rats. Acquisition of a bar press response was considerably slower than rates observed with immediate reinforcement; however, no significant differences between hippocampally lesioned and control groups were noted regarding training to criteria or ratio of responses to reinforcements. These results suggest that the hippocampus is not essential for the association of temporally discontinuous stimuli, and that deficits in other forms of associative learning, such as spatial cognition, must be mediated by the loss of other functions. Putative functions and underlying substrates are discussed for response modulation and sensory (cue relations) associations.

Animals↗
PubMed1993

Perceptions of VA chiefs of staff on total quality management implementation.

A national survey of United States Veterans Affairs (VA) Medical Centers (n = 167) chiefs of staff was conducted. The survey solicited feedback of the attitudes and perceptions of respondents toward planning, implementation, and monitoring of the Total Quality Management (TQM) process in their facilities. A Likert scale type of responses were collected and analyzed to measure the degree of agreement or disagreement of the respondents to survey statements on TQM. The survey included responses to three sections of the questionnaire: 25 statements on TQM, information on the TQM process status in the facility, and demographics of respondents and their facilities. The results of the survey indicate a considerable involvement of responding chiefs of staff in the TQM process and indicated their willingness to support it. Respondents agreed that TQM requires time and commitment of top management, and, again, they indicated their willingness to devote the time necessary for the process to succeed. They were, however, cautious in endorsing the statement that TQM will decrease health care costs (fiscal and human). The survey provides information that should prove valuable to administration in planning TQM and Continuous Quality Improvement efforts.

Adult↗
PubMed1992

Effect of sequential and daily continuous hormone replacement therapy on indexes of mineral metabolism.

BACKGROUND: Continuous regimens of estrogen-progesterone have recently been favored over sequential regimens because of a lower incidence of withdrawal bleeding. To determine whether the beneficial effects of sequential hormonal therapy on bone metabolism are preserved with the newer continuous regimens, we studied indexes of skeletal metabolism and changes in bone mineral density during a 1-year prospective trial. METHODS: Our subjects were randomized to one of three treatment groups: those in group C-2.5 were treated with 0.625 mg of conjugated estrogen with 2.5 mg of micronized medroxyprogesterone acetate daily continuously; group C-5 received 0.625 mg of conjugated estrogen and 5.0 mg of micronized medroxyprogesterone acetate daily continuously; and group S-5 received 0.625 mg of conjugated estrogen on days 1 through 25 and 5 mg of micronized medroxyprogesterone acetate on days 14 through 25. RESULTS: At 1 year, all groups demonstrated a significant decrease in indexes of bone formation turnover, including decrements in alkaline phosphatase levels of 11% to 30% and in osteocalcin levels of 45% to 60%. Intact parathyroid hormone levels rose 10% to 20%, with a concomitant near-significant decrement in ionized calcium levels at 12 months. In addition, there were significant decrements in the 24-hour urinary calcium-creatinine ratios and hydroxyproline-creatinine ratios of 13% to 28%, measures of bone resorption. Linear regression analyses showed that the subjects with the high bone resorption achieved the greatest increment in bone mineral density in response to hormone therapy. CONCLUSION: The daily continuous estrogen-progesterone regimens are as efficacious as sequential hormonal therapy in decreasing indexes of bone turnover and stabilizing bone mineral density of the spine and proximal femur.

Bone Density↗
PubMed1992

Dual-energy x-ray absorptiometry of the forearm: reproducibility and correlation with single-photon absorptiometry.

Although single-photon absorptiometry (SPA) has been the predominant tool used to assess bone mineral density (BMD) in the forearm, the development of dual-energy x-ray absorptiometry (DEXA) provides the benefits of greater source stability, reduced scanning time, and improved image resolution compared to SPA. In the present study we used the DEXA bone densitometer (Hologic, Inc., Waltham, MA) to (1) measure BMD in the one-third radius and ultradistal radius; (2) examine the reproducibility of these BMD measurements; and (3) compare the BMD at the one-third radius with SPA (SP2, Lunar Corp., Madison, WI). In 65 normal women (ages 22-74 years) we examined changes in the forearm DEXA BMD with age, revealing significant quadratic regression equations. The reproducibility of DEXA BMD (mean +/- SEM) in 7 normal subjects aged 22-50 years is 0.85 +/- 0.16% for the predominantly cortical one-third radius site and 0.97 +/- 0.15% for the more trabecular ultradistal site. The regression relationship between DEXA and SPA of the one-third radius in 26 subjects (ages 22-68 years) is DEXA BMD = 0.105 + 0.826 (SPA BMD); R = 0.97, R2 = 0.94, p less than 0.0001. Bone densitometry of the forearm using DEXA may be performed relatively rapidly, providing reproducibility and image resolution that are generally superior to those observed with SPA.

Absorptiometry, Photon↗
PubMed1990

Effects of sex, race and year in college on self-reported drinking-related problem behaviors.

This research was conducted to study the effects of sex, race, and year in college on self-reported drinking-related problem behaviors. It was hypothesized that men would report more problem behaviors than women, white students would report more than Hispanic or black students, and an interaction of sex and race would be observed. The study was conducted at a middle-sized eastern college, where 181 students anonymously filled out a 17-item questionnaire. The design was a 3 (race) x 2 (sex) x 2 (year in college) factorial. The hypotheses for sex and race were confirmed. Investigation of whether these self-reported drinking-related problem behaviors are congruent with actual behaviors requires study.

Adult↗
PubMed1987

Long-term results of conservative and operative management in complete paraplegics with spinal cord injuries between T10 and L2 with respect to function.

This study analyzed 87 athletes attending the Para Olympic Games at Stoke Mandeville in 1984. All athletes had had complete neurologic lesions between the levels of T10 adn L2. Clinical details were obtained from each athlete. Assessment then consisted of measurement of spinal movement in the sagittal plane using spondylometers and movement in the rotation plane using a rotameter. Body trunk strength was measured with the athletes in their own wheelchairs using a myometer. This gave a recording of kilograms of force. Trunk balance was assessed on both a static and a dynamic basis. The age, sex, follow-up period, and body weight for both spinal fusion and conservatively treated groups were similar. There was little difference in the incidence of pain between those treated by conservative and operative methods. There was statistically significant difference in the range of sagittal plane and rotation movement. There was no difference in flexor trunk power measured with the myometer between the two groups, but when extensor power was measured it was found to be 25% less in the spinal fusion group. There was no difference between the two groups when tested for static and dynamic trunk balance. Two other athletes who had had spinal fusions extending from the upper thoracic region to the sacrum showed unusually poor trunk stability. Overall, this study demonstrates that spinal fusion, particularly over multiple segments in complete paraplegics, has a deleterious effect not only on spinal movement but also on body trunk strength.

Adolescent↗
PubMed1973

Long-term survival of HeLa tumours in mice treated with antilymphocyte serum.

During studies of the ability of antilymphocyte serum (ALS) to suppress the immune mechanism of mice and thereby allow HeLa cells to grow into a large tumour in the mice, it was observed that many tumours continued to grow even after the ALS treatment had been stopped and full immunological competence of the mice had returned. The HeLa cells of such tumours appeared to be unchanged in their ability to induce further tumours in ALS treated mice to which they were transferred and, furthermore, the mice which were carrying such tumours in the presence of immunological competence were able to reject additional injections of HeLa cells or other human tumour cells. The four possible explanations for this phenomenon, (i) depression of cellular response; (ii) local reaction at the graft site; (iii) the presence of a blocking factor; and (iv) the elevation of the humoral response, have been investigated.

Animals↗